When is D6214 used?
The D6214 dental code applies to pontics constructed from titanium and titanium alloys, commonly utilized in fixed partial dentures (bridges) for replacing absent teeth. This code specifically identifies the material composition and differs from other pontic codes like those for ceramic or high noble metal materials. Apply D6214 when fabricating and placing a titanium pontic as part of a fixed bridge restoration, confirming the material aligns with CDT specifications. This code does not apply to removable appliances or pontics constructed from alternative metals or ceramic materials.
D6214 Charting and Clinical Use
Proper documentation is essential for claim approval. Clinical records must clearly document:
The edentulous area (location of missing tooth)
The rationale for fixed bridge treatment and titanium selection based on patient factors (such as allergic reactions, strength needs)
Pre-treatment and post-treatment radiographic images
Comprehensive charting of abutment teeth and pontic location
Laboratory orders specifying titanium materials
Typical clinical applications for D6214 include patients with metal sensitivities, those needing high-strength biocompatible materials, or situations where titanium offers superior long-term performance. Always confirm that the clinical justification for selecting titanium is thoroughly documented in patient files.
Billing and Insurance Considerations
Processing D6214 claims requires careful attention to prevent rejections and processing delays. Follow these practical steps for claim success:
Confirm benefits: Prior to treatment, verify the patient's insurance coverage for bridge work and material-specific benefits. Titanium pontic coverage varies by plan.
Obtain pre-approval: File a pre-authorization request with supporting materials, including X-rays and clinical documentation justifying titanium selection.
Code precisely: Apply D6214 exclusively for titanium/titanium alloy pontics. For different materials, use the correct corresponding code, such as D6205 for ceramic pontics.
Include documentation: Submit lab receipts, clinical photographs, and detailed narratives with claims to demonstrate medical necessity.
Monitor payments: Review benefit statements for payment correctness and identify any downgrades or rejections for potential appeals.
File appeals when necessary: For denied claims, submit appeals with comprehensive documentation highlighting the clinical requirement for titanium materials.
How dental practices use D6214
A patient presents missing tooth #19 with documented nickel sensitivity. Following consultation, the dentist suggests a fixed bridge featuring a titanium pontic for optimal biocompatibility. The practice records the allergy history, captures diagnostic images, and files a pre-authorization with detailed narrative. After receiving approval, the laboratory creates a titanium pontic. The claim gets processed using D6214, accompanied by lab documentation and clinical records. Insurance processes payment per plan benefits, and the practice posts payment while reconciling accounts receivable. This systematic approach ensures regulatory compliance and optimizes reimbursement outcomes.
Common Questions
Do reimbursement rates vary for D6214 versus other pontic materials?
Reimbursement rates for D6214 (titanium pontic) typically vary compared to pontics constructed from alternative materials like porcelain-fused-to-metal or all-ceramic options. Insurance providers frequently establish distinct fee schedules based on material composition, with some plans potentially downgrading payments to match the least costly alternative treatment. It's essential to confirm patient plan specifics beforehand and maintain readiness to submit appeals with comprehensive supporting documentation when downgrades occur.
Is D6214 suitable for use in both front and back teeth areas?
D6214 is applicable for both anterior and posterior tooth regions, though it's predominantly recommended for posterior applications due to titanium's exceptional strength and longevity characteristics. For front tooth restorations, aesthetic factors may favor alternative material choices unless the patient's specific clinical requirements necessitate titanium's unique properties.
What steps should a dental practice take when D6214 claims are rejected despite adequate documentation?
When D6214 claims face rejection, first examine the Explanation of Benefits to identify the denial rationale. For denials citing material restrictions or insufficient medical necessity, develop a comprehensive appeal strategy. Submit a detailed medical necessity letter, supplementary clinical documentation, and relevant supporting evidence including allergy records or documentation of previously failed restorations. Consistent follow-up communication and clear correspondence with insurance carriers frequently results in successful claim resolution.